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NUR732 Promoting Sustainable Change In Health Care

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NUR732 Promoting Sustainable Change In Health Care

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Course Code: NUR732
University: Thomas Edison State University

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Country: United States

The  purpose  of  this  assignment  is  for  the  student  to  present  a  critical  analysis  of  the  literature  on  leading,  managing  and  sustaining  change  in  health  care.  This  will  include  a  personal framework for leading change in future work and should incorporate a strength based approach that would fit their own context.  
Introduction and Background
Healthcare organisations are some of the most complex institutions partly because of the confluence of different healthcare practitioners since they bring on board competing viewpoints, interests, and time horizons in the management of different healthcare policies and strategies (Mitchell, 2013). Instituting changes to address various healthcare concerns in such a complex and multifaceted environment can indeed be a daunting task but possible (Ham, Kipping, and McLeod, 2003). It requires grounded leadership from the government and healthcare institutions as well as tighter cooperation amongst healthcare practitioners. Healthcare stakeholders must articulate a firm and common understanding of what leading, managing and promoting sustainable change is as well as its implications (Parkin, 2009)
This paper focuses on how change implementation can be lead, managed and sustained over time in an ever dynamic healthcare environment. In doing so, a critical review of the literature on sustainable change will be examined. This literature review will then inform the description of my personal framework for leading, managing and promoting sustainable change in my future role as a nurse leader-manager in a theatre environment.  
Literature Review
To successfully facilitate change in the healthcare industry, healthcare stakeholders must be well acquainted with how change happens in order to come up with a conducive environment for leading, managing sustainable change (Barr, 2016). Van de Van and Poole, (2000) assert that the change management process is not only complex but also very non-sequential. Healthcare providers are bound to experience change either as change agents or change targets (Grenny, et al., 2013). The change agents are the stakeholders bestowed with the authority and powers necessary to effect change policies in practice while change targets are those stakeholders the organization recognises as being part and parcel of the change itself. Change agents include policy makers, consultants, and managers while change targets include ordinary employees but some stakeholders may be both change agents as well as change targets (Varkey, & Antonio, 2010).
Cultivating a healthcare environment that supports and promotes sustainable change by and large demands the attainment of commitment of both of these stakeholders. Gaining commitment plays a big role in overcoming resistance to change from stakeholders who may feel left out in the planning, formulation, and implementation of change initiatives (Bridges, 2009). Commitment can be achieved by first assessing the motives of all stakeholders bound to be affected by change besides finding out if they perceive change as positive or negative for the healthcare organisation.  Individuals must be in a position to perceive that eminent changes are for the good of the organisation and that the benefits of the changes proposed far outweigh the disadvantages (Battilana, et al., 2010).
Leading, managing and promoting sustainable change in the healthcare industry is extensively underpinned by certain critical elements central to the healthcare sector as was aforementioned.  
These are; strength based approaches, appreciative inquiry, interpersonal and intrapersonal stakeholder relationships, and engagements, governance and leadership, communications,  obtaining and maintaining key stakeholder buy in, and measurement, monitoring and evaluation (Antwi & Kale, 2014).
Strength-based Approaches
Strength-based approaches tap on the strengths persons, organisations, relatives, and teams exhibit and by extension positioning these assets to facilitate change and empowerment (Hammond, 2010). Essentially, strength-based approaches to sustained change exploit the assets different people hold to influence their own betterment. Strengths that individuals, groups and organisations exhibit include skills, experiences, connections, and knowledge. Healthcare practitioners should identify these strengths and mobilise them to effect necessary sustained changes.  
Focussing on strengths does not necessarily insinuate assuming the presence of challenges or trying to sway them into strengths but it means finding opportunities within one’s capacities significant at solving these challenges. As a change strategy, strength-based approach calls upon healthcare practitioners to work in collaboration with those seeking support by assisting them to carry out things by themselves. (Hughes, 2008). As such, individuals cease from being just consumers of support to become co-producers of the very support (Morgan & Ziglio, 2007). However, McMillen, Morris, and  Sherraden, (2004); Staudt, Howard and Drake, (2001) have openly criticised strength-based approaches by advancing that these approaches are no different from most traditional approaches besides not being evidence by research. To salvage this strategy from condemnation as an important change strategy, different disciplines have used various terms to define it. In mental health, positive psychology and recovery are perceived as efficient describers of strength-based approaches. Community development uses the term “asset-based” while practitioners in prevention are inclined to use the term “resilience” (Petersen and Seligman, 2004).
In efforts of leading and managing sustainable change in healthcare, these varying terms can be pretty confusing. To this end, Rapp, Saleebey, and Sullivan (2008) advanced six standards that practitioners can employ in determining what exactly constitutes a strength-based approach. First, the strength-based approach is goal oriented meaning it is aimed at achieving specific set goals. Secondly, the approach is aimed at assessing the strength of those seeking support   since individuals are embodied with recourses that can enable them to overcome their adversities. Thirdly,  the environment has resources that individuals can exploit to ease any difficulties at their disposal.
It is the role of practitioners to identify the environmental resources that can lead and sustain change in the health status of their patients. Fourthly, strength-based approaches exploit explicit methods for determining both patient and environmental strengths to achieve set objectives. Fifthly, relationships built by strength-based approaches are meant to elevate the hopefulness of patients as well as affirming relationships with people and communities. Lastly, strength-based approaches capacitate people to make informed decisions and choices.
Appreciative inquiry
Appreciative inquiry (AI) as a change management strategy is concerned with determining what strategy works best for an institution, finding out why the strategy works well and moving ahead to implement it more in future endeavours (Lewis, Passmore, & Cantore, 2016). The leading principle underpinning the appreciative inquiry change strategy is that an organisation will always grow in whatever orientation the stakeholders in the organisation adopts (Messerschmidt, 2008). To this end, if a healthcare organisation decides to focus more with challenges and problems, then determining problems and challenges likely to impact the organisation and finding solutions to them is what the institution will do best. On the contrary, if the healthcare organisation instead focuses attention on organisational strengths, then the focus is laid at identifying strengths and developing those strengths and this consequently becomes what an organisation can do best (Bushe, 2013).
In leading and managing change for sustainability purposes, appreciative inquiry demands that change agents ask change targets specific guided questions in a way that promotes positive thinking as well as an employee to employee communication (Cooperrider, 2013). The questions lay emphasis on four critical areas; discover, imagine, design and deliver (DIDD). Discover questions are aimed at facilitating the determination of change cues that are beneficial and work efficiently for the organisation. Imagine questions are instrumental in analysing why specific processes work well besides helping in brainstorming strategies of replicating them elsewhere in the future. Design questions are inclined at creating an action plan while deliver questions are concerned with the creation of a criterion for evaluating success.
Appreciative inquiry has been lauded as having the possibilities of instigating a paradigm shift in sustainable organisational growth and development (Whitney, Trosten-Bloom, & Rader, 2010). It advances a radical departure from the commonly used problem-solution-based change approaches to a more positive, strength-based change management strategy. Branson (2016) assert that AI’s focus in leveraging on the healthcare organisation’s “positive core” strengths and its abilities in designing as well as redesigning organisational systems for sustained changes in the future is a significant facet in leading and managing changes. Cooperrider, Whitney, & Stavros (2008) contend that AI provides a deeper, more significant and sustainable change management approach that touches the core of any organisation.
Interpersonal and intrapersonal Intelligence
Having formidable interpersonal and intrapersonal skills is very critical in efforts of leading, managing and promoting sustainable change in the healthcare industry (Grenny et al., 2013). Interpersonal skills are the skills that help us to effectively interact and communicate with others at the individual and at the group level. To this end, interpersonal intelligence enables us to have the capacity to experience other people’s emotions and social needs. Robb (2004) assert that communication is the primary facet of leading and managing sustainable change. Varky and Antonio (2010); Mustain, Lowery, and Wilhoit (2008); Trajkovski, Schmied, Vickers, and Jackson, (2013) agree that communication not only inspires participation, and teamwork but also focussing on positive strengths as advocated for under appreciative inquiry. Nixon, (2014) assert that change message is critical while Kotter, (2012) and Braithwaite, Runciman, and Merry (2008) believe that behaviours ought to be harmonious with change messages which also need to be “sticky” for easy remembrance
Papa and Bonanno (2008) insist that good leaders need to be in a position to effectively communicate with fellow employees, motivate and inspire them to adopt proposed changes. Under transformational leadership, leaders are expected to communicate the goals of proposed changes with great empathy to allow their assumption not to face resistance (Northouse, 2016; Laschinger, 2010)). Effective listening, negotiation, problem and conflict solving skills are also very critical to this end (Petersen & Seligman 2004). These help eliminate hindrances that may make resistance to change real. Healthcare practitioners with good interpersonal skills have a tendency of working better in teams and in groups (West, 2012). This creates an ample platform of instigating and promoting change processes. Interpersonal intelligence calls upon leaders of change to remain emotionally intelligence which by extension allows them to make informed change decisions (Canevello, & Crocker, 2011).
Intrapersonal intelligence advances change agents with an opportunity to understand themselves by appreciating their emotions, goals, interests, motivations, and fears in the course of leading and managing important organisational changes (Walther, et al., 2010). Healthcare leaders must self-reflect and sole find themselves to be in tune with inner drivers such as intuitions, wisdoms, feelings, patterns, and connections that can have a direct influence on organisational changes. Intrapersonal intelligence, therefore, advances a more critical-thinking approach in leading and managing changes   (Marquis, & Huston, 2015).
Credible clear-cut leadership is very key in leading change sustainably. A good composition of exemplarily high performing, transformative leaders from different strata of the healthcare organisation are critical to this end (Ham et al., 2003). Leaders ought to embody themselves with leadership qualities, bear the vision and mission of the organisation besides having abilities of singling out organisational instances that deserve changes (Beaudan, 2006). This according to Maragh (2011) enables leaders to remain in control in the face of organisational adversity by propelling stakeholders adopts particular change initiatives. Transformational leadership calls upon healthcare leaders to remain inspiring, motivational and influencing to be in a position to command the adoption of changes by followers (Doody & Doody, 2012).
Obtaining and maintaining key stakeholder Buy-in  
No change can take place without the acceptance and acknowledgement of key stakeholders. Christi et al., (2010) perceive that low acceptance of change by employees is likely to lead to overall resistance by all employees.  Indeed Kotter (2008) insist that without calling for a sense of emergency to appreciate the need for change from key stakeholders, change is bound to fall by the wayside even though initiation has already taken place. Though Kolb, (2003) perceive that leaders’ clarion-call for change is by and large obsolete in the current times since the rate of change seems to supersede the necessity of calling it, Beaudan (2006) warns that organisational continuity through persistent call for change is vital in order to keep up with organisational environmental dynamism.
Measuring, monitoring and evaluating change
Finding out how well change initiatives have taken place is very and putting measures of preventing relapse to old dogmas is very critical as leading, managing sustainable change. When healthcare leaders keep tract of advancements, success, and failures from particular change initiatives, they can be in position to initiate institute restorative mechanisms where necessary (Beaudan, 2006). This not only motivates the rehabilitation of the change process but also gives employees an opportunity to enjoy their success too. This is key for sustainability of any change process.
Lucey (2008) observe that lack of monitoring and appraising of the aftermath effects of any change initiatives explains the reasons for change decline while Beaudan (2006) call upon healthcare leaders to be cautious of fatiguing the change process and that any signs to such effect ought to be corrected immediately. Though checklists can be instrumental in monitoring and evaluating change progress, their use without tutelage and continual backup can easily lead to discouragement and scepticism which may by extension impact on teamwork (Aveling, McCullouch, & Dixonwoods, 2013)
My change management framework
Upon completion of the literature review on leading, managing and promoting sustainable change, I will at this juncture outline my personal framework for the same. I will draw insights from this literature review. Since the personal framework is to be employed in the management of future change initiatives in an operating room environment, I will tailor the framework in my current role as a theatre nurse.
Strength-based Approaches
Strength-based approaches have been showcased as very significant at instituting change and sustaining it for a long period of time (Tomey, 2009). I will, therefore, exploit my inner   strengths as determined by VIA Institute on Character to inspire and influence change requirements at the theatre environment where I work. The VIA institute of character analysis brought out my character as one person who is of good judgement, have abilities to persevere, possess good leadership qualities, have a good sense of humour and is by and large kind to myself and others.
These strengths, therefore, bring me   out as a person who can impact transformational leadership to fellow healthcare practitioners at the operating room. Transformational leadership as advanced by Bass (1985) and Burns (1978) is very instrumental at swaying change outcomes through their ideas of individual consideration, inspirational motivation, intellectual stimulation, and idealised influence.  These strengths will be instrumental at not only spurring changes needed but also will be vital at inspiring, motivating and influencing the same across the entire operating room.
I will in most times remain non-judgemental and when required I will apply my judgement skills empathetically and kindly in a bid to bring out the positive side of my fellow nurses and without necessarily hurting their egos and esteems as their nurse-leader. This will nurture the capacities of assumption of change initiatives as well as curbing any resistance that may arise (Burnes & Jackson, 2011). I will use perseverance and humour to drive the point that amidst theatre environment adversities, trauma, and burnout, nurses can still adopt necessary changes and come out more resilient than before by exploiting the strengths/assets hidden in their inner core.
As a nurse leader, it is my prime duty to identify fellow theatre nurses’ strengths and mobilising them to effect necessary sustained changes.  Rapp, Saleebey and Sullivan (2008) advance that strength-based approaches are goal oriented and are instrumental at effecting changes for purposes of elevating hope in those seeking healthcare services. To this end, I will strive to strengthen relationships at the workplace for purposes of working as teams in meeting particular change targets.
Appreciative inquiry
In taping the opportunities presented by appreciative inquiry, I will put efforts in determining what works best for the operating room and by extension finding strategies of implementing the same. In achieving this, I will engage all stakeholders concerned in a brainstorming session, draft questionnaires with questions touching on the same besides engaging on a one on one interview. This will give me a green light of what changes are needed and how exactly to implement them. Engaging fellow nurses in a change planning, formulation, and implementation adventure  removes possibilities of resistance and assumption of the same trickles down more smoothly (Grol, Wensing, Eccles, & Davis, 2013).
Since the leading principle of appreciative inquiry in influencing change is that an organisation will move in the direction that stakeholders in it adopts, my principle focus to this end will be geared at influencing fellow nurses to adopt and embrace a strength-based approach in performing their duties (Cooperrider, Whitney, & Stavros, 2008). Appreciative inquiry and strength-based approaches advocate for the need to identify the “positive core” strengths individuals, groups and organisation hold in mediating their own change endeavours (Bushe, 2013). To this end, I will institute a search finding mission to find out exactly what constitutes the strengths of my theatre interdisciplinary team and by extension banking on this strengths to inform sustainable change.
Interpersonal and intrapersonal Intelligence
Communication has been lauded as a very primary interpersonal skills asset paramount in leading, managing and promoting sustainable change (Grawitch, Ledford Jr, Ballard, & Barber, 2009). Following its significance to this end, I will endeavour to cultivate my communication prowess throughout the theatre unit. I will implement this by instituting clear and open systems of communicating critical change concerns horizontally between change targets well as vertically between change targets and change agents.
I will have in place several communication channels through which different stakeholders will channel their concerns, recommendations and change action plans. These include having a theatre unit website and email upon which major events, activities and change action plans will be being communicated on and action plans sort. Moreover, in addition to leveraging on direct interpersonal communication cues, I will also orient my workforce to interact through social media platforms which by and large improve connectivity of employees even when they are off duty. Social media communication posits the potential of further identifying positive team strengths as advocated for under the appreciation inquiry and strength-based approaches (Vickers and Jackson, 2013).  To illicit continuous debate and dialogue concerning change initiatives, I will employ diffusion to catalyse the same by putting across points that are likely initiate a heated debate on how exactly change is supposed to be adopted and executed.
In complimenting communication, I will also pay a lot of emphasis to effective listening, negotiation, problem and conflict solving skills, emotionally intelligence as they are instrumental at eliminating resistance to change. Those passionate to leading and managing change both at the personal level and at the theatre unit level will be appreciated and encouraged to maintain changes in their teams (Braithwaite, Runciman, & Merry, 2009).
Lastly, I will endeavour to improve on my intrapersonal intelligence. Empirical research has proven that when leader-managers exploit their inner intuitions, wisdoms, emotions, goals, interests, and motivations, they are bound to lead and manage more holistic changes than when they only rely on evidence (Walther, et al., 2010).  To this end, I will always self-reflect and sole to allow me to be in tune with inner drivers with direct influence on organisational changes.
As a leader-manager, provoking stakeholders to keep talking about change will be very crucial in my change framework. To this end,  and like Salmela, Eriksson, and Fagerström, (2012) observed, I will be proactive in seeking and listening to their opinions and concerns which will later be instrumental at informing a participatory approach in leading, managing and sustaining changes ((Bevan, Plesk, & Winstanley, 2014)). Since my position in my change management framework is that of an enabler, motivator, inspirer, mentor and influencer, I will customised the theatre environment to accommodate circumstances that not only give change a chance to thrive but also that motivate stakeholders to dig deeper in their thoughts on how best such changes can be implemented (Plowman et al., 2007; Hamel & Zanini, 2014).
Achieving this will necessitate me to exploit appreciative inquiry approaches (Hammond, 2013); systems thinking’s positive and negative feedback loops (Weberg, 2012) and the influence model constructed by McKinsey and Company (Bevan, Plesk, & Winstanley, 2014). In doing so, I will intensively educate and train fellow nurses on the need for change; provide means and ways of effecting change; make and share critical decisions; provide direction besides motivating them to launch change initiatives on their own (Hoch, 2013; Hamel & Zanini, 2014).
Hamel & Zanini, (2014); Pelligrin, (2011) observe that providing change platforms to both change agents and change targets advances opportunities for innovation, stronger engagement, empowerment, mobilisation and organisational culture absorption besides reducing change resistance possibilities. Lastly, Like Kotter (2012) advocates that change need to be led by example and role modelling; I will make efforts to lead the same my matching my verbal rhetoric to my deeds.
Obtaining and maintaining key stakeholder Buy-in  
My change management framework will more or less deal more with people that appreciate the power of making calculated changes whenever they are deemed necessary. Like Kotter’s (2012) change, cycle insists that for change to happen, then a sense of agency is necessary to evoke change   through a dedicated team to change, I will occasionally be doing the same. This will allow my fellow theatre team to always remain in a change mood for more future changes (Watkins, Mohr, & Kelly, 2011).  Listening to teammates demands, having group storytelling, diffusion and appreciative inquiry sessions advances opportunities for sharing past success, discussing innovative change ideas, recognition of attributes and expertise as well as breaking existing generational boundaries and dispelling failures (Richer, Ritchie, & Marchionni, 2009 ; Cooperrider, Whitney, & Stavros, 2008).
As stakeholder Buy-in strategies, appreciation inquiry and strength-based approaches acknowledge the significance that dialogue can have in a change planning and implementation adventure (Carter, 2006). I will, therefore, utilise the two in my change management framework to influence visualisation of positive outcomes of sustained change. As opposed to fault-finding, problem-solving and laying blames to particular employees, I will concentrate my change framework on exploiting the positive virtues and strengths people and the environment presents (Trajkovski, Schmied, Vickers, & Jackson, 2012).
Measuring, monitoring and evaluating change
Measuring, monitoring and evaluating criteria for various change strategies, approaches, and their outcomes will be very paramount in my change management framework as they. Lucey (2008) warn that lack of proper change appraisal criteria explain the reason for high rate of failure for most change initiatives.  I will use well thought modes and criteria for the same to avoid fatiguing theatre employees with unreachable targets. In doing so, I will employ a minimalist strategy that primarily focus on strategy and outcome usefulness. Measurement and evaluation systems which are clear-cut and malleable to specific outcomes will be used to allow staffs concentrate with particular objectives (Dorizois, Langlois, & Blanchet-Cohen, 2010. Periodically, a review of measurement will be conducted to ascertain the usefulness and relevance of change strategies for further implementation consideration.
A key strategy to be used in evaluating my change management framework for sustainable change will be developmental evaluation. This strategy is not only flexible, adaptable but also allows for smooth change assessments in complex and multifaceted workplace setups such as a hospital theatre rooms (Patton, 2008). Moreover, developmental evaluation allows for real time learning which by extension assist make responses fast and calculated
Leading, managing, and promoting sustainable change is a vital part of healthcare following the fact that change in healthcare institutions is unremitting (Yoder-Wise, 2015). This assignment has comprehensively unearthed through a personal change management framework how change can be led, managed and sustained over time in a complex and multifaceted theatre room condition. Literature review on the same has been performed to inform the framework. By and large, it has been deduced that customising elements that affect the change process to particular healthcare units is paramount to achieving sustainable healthcare outcomes. The change framework described here is aimed at encouraging change agents and change targets assume positive insights in their adoption of change initiatives as determined by Suchman, Sluyter, & Williamson (2011).   
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